Mitt Romney on Health Care

Former Republican Governor (MA)

Mandating citizens to buy health insurance is conservative

With regards to my health care plan, let me describe what is the ultimate conservative approach. In this country, you have today about 47 million people that don’t have health insurance. We went out and tried to find out why they don’t. We found out that
about half of them could afford to buy insurance if it were reasonably priced. They could afford to buy it, but they weren’t buying it. it? If we get sick, we can go to the hospital and get care for free.“ And we said: what? If somebody could afford
insurance, they should either buy the insurance or pay their own way. They don’t have to buy insurance if they don’t want to, but pay their own way. But they shouldn’t be allowed to just show up at the hospital and say, somebody else should pay for me.
So we said: No more free riders. It was like bringing “workfare” to welfare. We said: If you can afford insurance, then either have the insurance or get a health savings account. Pay your own way, but no more free ride. That was what the mandate did.

Get everyone some form of catastrophic health coverage

We found a way to get everybody insured with private free-market health insurance. I do support an effort to get everybody some form of catastrophic coverage. It may be a public-private partnership between private insurance industries and the federal
government. It may be done with the states. But I’ll bring together the governors of all 50 states, leadership in Washington, and industry representatives, to say, “What’s the right way to fashion this that makes the most sense for the people of America?

Source: 2008 GOP debate in Boca Raton Florida
Jan 24, 2008

FactCheck: Untrue that 47M uninsured want to “not play”

Romney offered a theory for the number of uninsured that is simply false. Romney said, “The reason health care isn’t working like a market right now is you have 47 million people that are saying, ‘I’m not going to play. I’m just going to get free care
paid for by everybody else.’ That doesn’t work.”

This idea--that most uninsured Americans simply don’t feel like having health insurance--is simply not the case: Most people who are offered insurance do not turn it down.
A 2007 study found that 20% of the uninsured could have afforded coverage, but even leaving aside other factors like being turned down for insurance, that’s hardly 47 million people refusing to “play.”

Romney is also misleading when he implies that
the uninsured are simply choosing between toeing the line and freeloading. While uninsured individuals can get a certain amount of free emergency care, it is by no means comparable to the care given to those with insurance.

Personal responsibility instead of employer mandates

Q: What should we do with all the millions of people who are not insured?

A: Well, I actually got the job done. Working with people across the aisle, we said: Enough is enough. Look, the best kind of prevention you can have in health care is to have a
doctor. And if someone doesn’t have a doctor, doesn’t have a clinic they can go to, doesn’t have health insurance to be able to provide the prescription drugs they need, you can’t be healthy. And you need to have health insurance for all of our citizens.
And I found a way to do that without requiring raising taxes, without a government mandate, without a government takeover. When I said government mandate, I meant employer mandate. Instead, we have personal responsibility. We allowed individuals to buy
their own policies. Those that couldn’t afford them, we helped them buy their policies. And you know what? It cost us no more money to help people buy insurance policies that they could afford than it was costing us before, handing out free care.

Let states create their own private, market-based insurance

Q: Does the health care plan you left in Massachusetts, which required people to get their own insurance, amount to HillaryCare? You say it was the result of a Democratic legislature.

ROMNEY: First of all, I’m not going to give the Democratic
legislature credit for the plan that I helped build. I think it’s a model that other states can adopt in some respects. But our plan is different than Hillary Clinton’s in a lot of important ways. For Democrats, they want to have government take it over.
The right answer is to get all of our citizens insured so they don’t have to worry about losing their insurance if they change jobs or have a preexisting condition. But Hillary says the federal government’s going to tell you what kind of insurance,
and it’s all government insurance. And I say no, let the states create their own plans, and instead of government insurance, [have] private, market-based insurance. Hillary’s plan costs an extra $110 billion. My plan doesn’t cost any additional money.

Removing most mandates drove down premium cost by half

HUNTER: Gov. Romney’s plan goes in exactly the wrong direction, because while it allows for private health insurance, it has lots of mandates. Those 1,000 or so mandates drive up the cost of health care by about 35%. We need freedom.
We need to allow people to buy their health care across state lines. That will bring down the cost of health care.

ROMNEY: We took as many mandates out as we could in our policies. And the legislature kept some there. I tried to take them all out;
they put some back in. It was a compromise. They put some mandates there. But, let me tell you how many we got out. The price of the premium for an individual, 42 years old, in Boston, used to $350 a month. Now, it’s $180. We basically cut it in half
by deregulating. Congressman, you’re absolutely right that taking regulation out of insurance brings the price down, and that’s why my plan would go state by state, deregulate them so we can get the cost of premiums down. We got the job done.

FactCheck: HillaryCare closer to RomneyCare than “all gov’t”

Romney attacked Hillary Clinton’s health care proposal. But the plan he enacted in Massachusetts is quite similar to Clinton’s. Romney said, “Hillary says the federal government’s going to tell you what kind of insurance, & it’s all government insurance.
And I say no, let the states create their own plans, and instead of government insurance, have private, market-based insurance.” Actually, the plan Romney brags about in Massachusetts shares a number of key characteristics with Clinton’s:

They both require that individuals obtain insurance and also require employers provide it.

They both provide government subsidies for those with low incomes.

Both expand the number of people covered under Medicaid.

Furthermore,
Romney’s claim that Clinton espouses “all government insurance” is false. Under her proposals, people could keep their current insuranc. It is true that Clinton’s plan would require much more government involvement than Romney’s nationwide proposal.

Same tax treatment if people buy insurance without employers

Our health care system right now really penalizes individuals that might want to buy their own insurance, as opposed to buying it through their company. And that’s why
I propose that people should be able to get their insurance individually, and it should be--and get the same tax treatment as to whether the company buys it for them, or they buy it for themselves. And all medical expenses would be tax deductible.

Source: 2007 Republican debate in Dearborn, Michigan
Oct 9, 2007

Get everybody insured with state-based market dynamics

The way we improve something is not by putting more government into it. In my view, instead, the right way for us to go is to bring in place the kind of market dynamics that make the rest of the economy so successful. So my plan gets everybody in America
insured, takes the burden of free riders off of our auto companies and everybody else, and says let’s get everybody in the system.

We’re going to have states create their own plans. We did it in our state, and it’s working. We’re not going to have
the federal government tell them how to do it.

MA plan blends personal responsibility & universal coverage

Romney says he is proud of the healthcare plan he masterminded for Massachusetts. It is a laudable plan that blends the Republican ideal of personal responsibility with the Democratic goal of universal healthcare.

Here’s a crash course in the 2006
Health Reform Statute. Every person is required to buy health insurance. Young, healthy people--who ordinarily wouldn’t buy health insurance--have to get it, even if they feel like they don’t need it. This inclusiveness lowers the premiums and allows
state funds that were earmarked for medical care for the uninsured to be used to provide insurance for the populace. Medicaid still covers the indigent.

Critics say this isn’t fair to require everyone to buy health insurance. But it’s as equitable
as requiring all drivers to buy automobile insurance. Everybody pays for the uninsured anyway, whether it’s in higher auto insurance premiums or higher hospital bills. Health insurance as a civic duty is a noble concept, but one that just may work.

Conservative idea: individual responsibility for health care

On American Healthcare: “The wonders of America--like our healthcare technology--can be powerful tools to promote the foundations of liberty. It is time that we apply these American wonders to make the world, and in turn to make
America, a safer, freer, and more prosperous place.”

On Insurance for All: “We can’t have as a nation forty million people--or, in my state, half a million--saying, ‘I don’t have insurance, and if I get sick, I want someone else to pay.
It’s a conservative idea, insisting that individuals have responsibility for their own health care. I think it appeals to people on both sides of the aisle: insurance for everyone without a tax increase.“

When asked to compare his program with that proposed by then-First Lady Hillary Clinton: ”Perhaps the biggest between our two plans was that mine got passed and hers didn’t.“

Insure 45 million uninsured with a free-market based system

It doesn’t make sense to have 45 million people without insurance. It’s not good for them because they don’t get good preventative care and disease management. But it’s not good for the rest of the citizens either, because if people aren’t insured, they
go to the emergency room for their care when they get very sick. That’s expensive. They don’t have any insurance to cover it. So guess who pays? Everybody else. So it’s not good for the people that aren’t insured. We have to have our citizens insured,
and we’re not going to do that by tax exemptions, because the people that don’t have insurance aren’t paying taxes. What you have to do is what we did in Massachusetts. Is it perfect? No. But we say, let’s rely on personal responsibility, help people buy
their own private insurance, get our citizens insured, not with a government takeover, not with new taxes needed, but instead with a free-market based system that gets all of our citizens in the system. No more free rides. It works.

FactCheck: Romney plan virtually identical to Obama plan

Romney tried to distance his state’s universal health insurance plan from the proposals of the Democratic presidential candidates. Romney said, “Every Democrat up there’s talking about a form of socialized medicine, government takeover, massive tax
increase. I’m the guy who actually tackled this issue. We get all of our citizens insured. We get people that were uninsured with private health insurance. We have to stand up and say the market works. Personal responsibility works.”

There are two
problems with Romney’s characterization: One, Ohio Rep. Dennis Kucinich is the only Democratic candidate to propose a single-payer, wholly government-funded health care plan. And two, Romney’s Massachusetts universal insurance system bears a striking
resemblance to the health care proposals of the Democratic front-runners. For example, the Obama and Romney plans are virtually identical. But in our view, the term “government takeover” could only be applied to Rep. Kucinich’s proposal.

Pharmaceutical companies create products to make us better

Don’t make the pharmaceutical companies into the big bad guys. Actually they’re trying to create products to make us well and make us better, and they’re doing the work of the free market.

And are there excesses? I’m sure there are, and we
should go after excesses. But they’re an important industry to this country. But let me note something else, and that is the market will work. The buyer doesn’t have information about what the cost or quality is, or different choices they could have.

Source: 2008 Facebook/WMUR-NH Republican primary debate
Jan 5, 2006

Subsidies for health coverage for low-income individuals

Opposed requiring employers to contribute to cost of health care plans for their employees, preferring subsidies for health coverage for low-income individuals and providing tax
incentives to individuals, including the unemployed and the self-employed, for the purchase of health insurance

Source: Boston Globe review of 1994 campaign issues
Mar 21, 2002

Voluntary purchasing pools

Favored creating voluntary purchasing pools through which small businesses and individuals could buy insurance

Pledged to cut health care costs through market-based reforms such as providing information on the price and quality of health care services to consumers.

Source: Boston Globe review of 1994 campaign issues
Mar 21, 2002

Mitt Romney on Mass Health Plan

FactCheck: MA employers have no mandates, but “requirements”

Romney made some questionable statements about the Massachusetts universal health care plan he signed into law, saying he opposed employer mandates: “When I said government mandate, I meant employer mandate.”

Massachusetts may not call its rules for
employers a “mandate,” but the state health care plan includes several “obligations” or “requirements,” as the state dubs them, for employers, along with fees for noncompliance. The requirements for employers are much narrower than those for individuals,
who indeed, according to the state, face a “mandate” to get health insurance.

But is a “requirement” a “mandate”? You be the judge: Employers with more than 10 full-time employees must pay at least 33% of employee premium costs or have a group health
plan. Those that fail to do so must pay a fee of $295 per full-time employee per year.

Individuals in the state must have health insurance. If not, they’ll lose their personal exemption on state income taxes in 2007--a penalty of $219.

FactCheck: No, MA healthcare plan is not paid for, yet

As for the cost of the Massachusetts universal health care program, Romney said, “It cost us no more money to help people buy insurance policies that they could afford than it was costing us before, handing out free care.” Romney can’t yet make the claim
that it has been completely paid for with the state’s “free care” money--funds used to pay for emergency health care for the uninsured.

The Massachusetts Taxpayers Foundation estimated that the state would need an extra $200 million each year for
2007 to 2009 to finance the health care plan, because more people enrolled in subsidized care than anticipated. That shortfall, however, is a projection, and a Boston Globe article on the budget gap said some money could be shifted from the free care
fund, if there is money in that fund to do so. Additional dollars came from a Medicaid waiver granted by the federal government, which is set to expire in 2009. The Massachusetts government is negotiating with federal officials to renew that waiver.

FactCheck: MA plan works, but Romney not proposing it for US

Romney now says he wouldn’t propose a Massachusetts-style plan for the nation, so the track record of the Massachusetts plan is a poor indicator of what Romney’s current proposals might accomplish nationally. And while his claim that his state plan
lowered premiums is correct according to the Commonwealth Connector, a state agency created to implement the plan, the group says that resulted from a legally required merging of small group and non-group markets, which is something states would be
allowed to do--but not required--under Romney’s current proposal.

It’s also unclear how many of the previously uninsured have gained coverage under the Massachusetts plan. While the program has successfully enrolled 200,000 people, some of those may
have switched from less desirable policies. A more apples-to-apples measure found that 395,000 people didn’t have insurance in the state in 2006, then a 10% decrease in the uninsured through July 2007.

MA program relies on personal responsibility & the market

A: As governor, I talked to people, and they say, “If I lose my job, I’m worried I’ll lose my insurance, and my
insurance premiums are getting higher and higher.” And we said: We got to find a way to get everybody insured. And the last thing we want is to have the government take over health care, because anything they take over gets worse. We said:
We need to find a way to get everybody in our state insured with private insurance. [We found] a way to get them insured without raising taxes, without a government takeover. It relies on personal responsibility. Every Democrat up there’s talking about a
form of socialized medicine, government takeover, massive tax increase. I’m the guy who actually tackled this issue. We get all of our citizens insured. We have to stand up and say the market works. Personal responsibility works.

MA health plan insures all without taxes or socialization

Q: A year ago, it seemed that you couldn’t wait to tell the world about your health-care experiment in Massachusetts. Since then, it’s been criticized by conservatives as something Hillary Clinton could’ve devised. You hardly mention it on your Web site.
What’s changed?

A: I love it. It’s a fabulous program. I’m delighted with the fact that we worked together across the aisle, Republicans and Democrats, to find a way to get health care for all of our citizens that’s affordable and that’s portable.
I helped write it and I knew it well, and this is a country that can get all of our people insured with not a government takeover, without Hillarycare, without socialized medicine. Instead, get the market to do its job. Let me people have health care
that they can afford. Get the market to do its job. Let people have the opportunity to choose policies in the private sector. We didn’t expand government programs. We didn’t raise taxes. There was no government takeover.

FactCheck: MA plan not yet in place so analysis premature

Romney called his state health care experiment “a fabulous program” accomplished without any “government takeover”. Romney’s praise, however, is a bit premature--and while the plan is not government-administered health insurance, it includes mandates for
individuals & employers, minimum coverage requirements, subsidized insurance & government-enforced fines for noncompliance.

Overall, it’s too soon to tell how successful the Massachusetts plan will be. The requirements for health coverage do not go int
effect until July. By April, nearly 70,000 people had signed up for subsidized health plans. That number is half of those eligible. But the total estimate of uninsured Massachusetts residents is 372,000. The state has a long way to go.

And it has hit
some snags in implementing the law. The initial bids from insurance companies were much more expensive than what Romney had touted, because over 200,000 insured residents would need to buy additional coverage to meet the original state requirements.

Signal accomplishment as Governor is MA insurance reform

Mitt Romney’s signal legislative accomplishment is health insurance reform.
Romney wrestled from the Massachusetts legislature in 2006 an important and sweeping set of innovations on how health insurance will be managed in Massachusetts.

MA reform focuses on individual responsibility (via fines)

To reform health insurance, Romney partnered with the Heritage Foundation. Of the approximately half-million uninsured in Massachusetts, about 200,000 were healthy risk takers who preferred spending dollars on goods other than premiums for health care
insurance they figured they would not need.

In fact thousands of those risk-takers end up needing health care, and of the expensive sort. The state and the care providers eat the costs, which means the taxpayer and premium payers eventually get the
bills. To this group, Romney gives no choice. In January, 2008, they must either insure themselves or be subject to a fine. The poor get subsidies as well as assistance in signing up.

The legislature tacked on a provision that penalizes companies of
11 or more employees that do not provide health insurance. Romney vetoed this add-on. The legislature overrode his veto. But the lawmakers still handed Romney an enormous victory. They did so because the plan manifestly makes sense.

State universal coverage plan is national test case

Massachusetts has become the pioneer in universal coverage [via Romney’s] plan for radically restructuring the health-care financing system. One piece is subsidizing low-income families’ purchase of private health insurance, instead of reimbursing
hospitals for treating the uninsured. The other big idea creates an insurance exchange-a public bank that will collect the premiums from individuals and pass them on to their chosen insurers-so individuals can buy health insurance with pretax dollars.

The program’s passage with overwhelming bipartisan support is a notable achievement. It remains to be seen how many uninsured people actually order policies. Romney remarked, “I wish I were going to be governor the next five years to see it through,” but
he will step down at the end of this year and is preparing to seek the presidency. Meanwhile, his health plan gives him a unique calling card-and provides the country with an important opportunity to test one possible solution to a vexing problem.

MA state health insurance plan lowered costs

We put in place a plan that gets every citizen in our state health insurance, and it didn’t cost us new money or require us to raise taxes. What we found was, it was less expensive or no more expensive to help individuals who had been uninsured by their
own private policy than it had been for us to give out free care at the hospital. Since we put our plan in place last April, we’ve now had 300,000 people who were uninsured sign up for this insurance, private insurance. Where good doctor was wrong is tha
it’s true the insurance companies don’t want to sell policies to one person at a time. It’s expensive. We established what we called a connector, a place where individuals could go to buy policies from any company, and that connector would in turn send
their premiums on to those companies. So the economics of scale existed. As a result, the premiums for health insurance for an individual buying insurance went from $350 a month to $180 a month, with lower deductibles and now with prescription drugs.

Mandates on health insurance work in Massachusetts

I like mandates. The mandates work. If somebody can afford insurance and decides not to buy it, and then they get sick, they ought to pay their own way, as opposed to expect the government to pay their way. That’s an American principle.
That’s a principle of personal responsibility. If you can afford to buy insurance, then buy it. You don’t have to, if you don’t want to buy it, but then you got to put enough money aside that you can pay your own way.
If people can afford to buy it, either buy the insurance or pay your own way; don’t be free-riders and pass on the cost to your health care to everybody else. It actually applies to people at three-times federal poverty. They pay for their own policy.
At less than three-times federal poverty, we help them buy a policy, so everybody is insured, and everybody is able to buy a policy that is affordable for them. One-quarter of the uninsured in my state were making $75,000 a year or more.